Abstract
Background
The relative importance of signs and symptoms in the diagnosis of otitis media has
not been adequately evaluated. This has led to a large degree of variation in the
criteria used to diagnose otitis media, which has resulted in inconsistencies in clinical
care and discrepant research findings.
Methods
A group of experienced otoscopists examined children presenting for primary care.
We investigated the signs and symptoms that these otoscopists used to distinguish
acute otitis media (AOM), otitis media with effusion (OME), and no effusion. We used
recursive partitioning to develop a diagnostic algorithm. To assess the algorithm,
we validated it in an independent dataset.
Results
Bulging of the tympanic membrane (TM) was the main finding that otoscopists used to
discriminate AOM from OME; information regarding the presence or absence of other
signs and symptoms added little to the diagnostic process. Overall, 92% of children
with AOM had a bulging TM compared with 0% of children with OME. Opacification and/or
an air-fluid level was the main finding that the otoscopists used to discriminate
OME from no effusion; 97% of children diagnosed with OME had an opaque TM compared
with 5% of children diagnosed with no effusion. An algorithm that used bulging and
opacification of the TM correctly classified 99% of ears in an independent dataset.
Conclusions
Bulging of the TM was the finding that best discriminated AOM from OME. The algorithm
developed here may prove to be useful in clinical care, research, and education concerning
otitis media.
Keywords
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Article Info
Publication History
Published online: March 29, 2012
Accepted:
January 19,
2012
Received:
August 22,
2011
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.